Guest post by Mark Hazelwood from Palliative Care Scotland.
Some Delicate Topics of Conversation
However healthy Scotland becomes, there will for all of us be times when the threat of dying intrudes on our lives and expectations.
It might be when the doctor diagnoses you with cancer. It might be when your child is born with a life-shortening condition. It might be when your mother starts to show the signs of dementia. It might be when you celebrate your 90th birthday. It might be when a colleague dies. It might be for a thousand other reasons.
When faced with the reality of deteriorating health and death, people need many things from our health and social care system, and from their friends, families and communities. Different people will want different things, but common threads often include maintaining autonomy, open and honest exploration of choices and uncertainty, and support to maximise wellbeing during the time remaining whether that be years, months or hours.
Most people know from personal experience the individual impact that success or failure in meeting these needs has, and therefore that this is a hugely important part of creating a Healthier Scotland. The scale of the challenge for our health and social care system, and for our society, should not be underestimated. 1 in 3 acute hospital beds are occupied by people in their last year of life and nearly 1 in 10 people in hospital will die during their current admission. The number of people dying is expected to go up by 17% in the next 20 years. Most of us will die when we’re over the age of 75, and with multiple health conditions.
The current National Conversation is an opportunity to discuss some delicate topics which lie at the heart of improving people’s experience of death, dying and bereavement. Policy makers need to be open and honest about the limits of medicine, but also emphasise that even as health declines our system can promote wellbeing, supporting people to live well until they die. Health and social care professionals need to create opportunities for the public to acknowledge the possibility of dying – without this it is hard to discuss a person’s preferences for care and to align our systems to meet those preferences. Without open and honest conversations a person’s chances of receiving the kind of care they would choose are reduced – people nearing the natural end of life may undergo futile and aggressive medical interventions at the expense of their quality of life. Studies show that doctors tend not to choose these same interventions when their own time to die is approaching.
Many other problems are caused because as policy makers, health and social care professionals, as people, as a society, we struggle to be open about death, dying and bereavement. 60% of Scots die without making a will, leaving potential for family conflict and financial and legal complications at an already distressing time. People who are dying or bereaved can experience isolation because family, friends and communities are afraid of saying the wrong thing.
A Healthier Scotland will be a place where:-
- People’s wellbeing is supported even as their health declines.
- People die well.
- People are supported throughout bereavement.
Without more openness in Scotland about death, dying and bereavement this vision will remain unrealised. Good Life, Good Death, Good Grief is an alliance of nearly 1000 organisations and individuals committed to increasing such openness www.lifedeathgrief.org.uk .
And finally onto another delicate topic of conversation. Death and taxes famously share the quality of inevitability. They also seemingly share the characteristic of being difficult to talk about. However, if as a country we are going to be able to resource our aspirations for better health and care (including improving death, dying and bereavement) our National Conversation should also incorporate discussion of whether as a society we are more wedded to American levels of taxation or to Scandinavian levels of health and social care provision.